Mar 4-April 28 is the Ethiopian Orthodox Great Holy Lent Fast lasting 55 days culminating on Easter April 28, 2019, observed by followers of the Ethiopian Orthodox Church.

The fast:

is applicable to all persons older than 13 years of age

involves total abstention from: meat, dairy products and eggs

instead, cereals and vegetables will be consumed

only one meal a day is eaten, taken in the evening or after 3:00pm

starting on Good Friday to Easter Sunday (April 26-28, 2019), there is total abstention from everything taken orally. Nothing is to be consumed.

on other Saturdays and Sundays during Lent, eating breakfast is allowed.

Medical implications:

doses of medications scheduled to be taken multiple times a day will either be missed or worse, some will try to make up for missed doses by doubling or tripling dosages.

illnesses dependent on regular meal intake for their control, will be difficult to control, i.e., DM, PUD.

diabetics and most patients with chronic systemic illnesses will be at increased risk the last 3 days of the fasting season, Good Friday to Easter Sunday (April 26-28, 2019).

on the day just before fasting starts, people feast all day; this requires clear advice to patients in anticipation of this feast day to adjust insulin appropriately.

Health care providers should be vigilant and ask their patients whether they intend to observe regular or modified fasting. Engage in a full discussion of the degree of the individual’s risk from fasting with the patient who intends to fast. For patients who prefer to fast, individualization of care and frequent monitoring is highly recommended. Patients often have experimented and developed their own regimen. Exploring this with the patient helps build a partnership between patient and provider, capitalizing on the knowledge of both parties.

Patients’ decisions to fast may need to vary year by year, and their participation in the fast may need to become modified as they become more fragile and unable to do the entire fast without risk of dehydration, hypoglycemia, or exacerbation of underlying illnesses. Medical assessment and educational counseling should be provided for all patients with chronic medical conditions that require daily medication. Advise patients with diabetes to monitor BG more frequently during fasting periods. Take into account how long the fast will last. Incorporate the patient’s experiences with control of chronic disease when fasting in previous years into current treatment recommendations.

When in the judgment of a provider, patient is considered at risk, provider can remind the patient of the exemptions stipulated by the Ethiopian Orthodox Church (the sick, travelers and the weak may be exempt from or reduce the fasting periods) and if necessary refer the patient to the Head Priest for counseling.